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HEALTH INSURANCE (DIAGNOSTIC IMAGING SERVICES TABLE) REGULATIONS 2006 (SLI NO 271 OF 2006)
EXPLANATORY STATEMENT
Select Legislative Instrument 2006 No. 271
Issued by the Authority of the Minister for Health and Ageing
Health Insurance Act 1973
Health Insurance (Diagnostic Imaging Services Table) Regulations 2006
Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides that the
Governor-General may make regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.
The Act provides, in part, for payments of Medicare benefits in respect of professional services rendered to eligible persons. Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for medical services, including diagnostic imaging services, set out in prescribed tables.
Subsection 4AA(1) of the Act provides that the regulations may prescribe a table of diagnostic imaging services that sets out items of diagnostic imaging services, the amount of fees applicable in respect of each item and the rules for interpretation of the table. The Health Insurance (Diagnostic Imaging Services Table) Regulations 2005 (the 2005 Regulations) currently prescribe such a table.
Subsection 4AA(2) of the Act provides that, unless sooner repealed, regulations made under subsection 4AA(1) cease to be in force and are taken to have been repealed on the day after the 15th sitting day of the House of Representatives after the end of a period of 12 months, commencing on the day on which the regulations are notified on the Federal Register of Legislative Instruments. The 2005 Regulations were registered on the Federal Register of Legislative Instruments on 24 October 2005 and commenced on 1 November 2005.
The purpose of the Regulations is to repeal the 2005 Regulations and to prescribe a new table of diagnostic imaging services for the 12 month period commencing on 1 November 2006. The new table will effectively reproduce the table contained in the 2005 Regulations, with some amendments to the rules of interpretation and the schedule of services and fees. The Regulations will set out the items of diagnostic imaging services which are eligible for Medicare benefits, the amount of fees applicable in respect of each item and rules for interpretation of the table.
Medicare funded diagnostic imaging services specified in the diagnostic imaging services table are managed between the Commonwealth Government (as represented by the Department of Health and Ageing) and relevant diagnostic imaging profession representative bodies through four “2003-2008 Quality and Outlays Memoranda of Understanding (MoUs)”. The four MoUs cover radiology, cardiac imaging, nuclear medicine imaging and obstetric and gynaecological ultrasound.
The Regulations will affect services specified under the Nuclear Medicine and Radiology MoUs. The Nuclear Medicine items will be amended to reflect the 1% fee increase approved by the Minister for Health and Ageing on 3 August 2006. The Australian and New Zealand Association of Physicians in Nuclear Medicine Inc. support these amendments. The Radiology items will be amended to provide for Medicare benefits to be paid for magnetic resonance imaging (MRI) services conducted using specified equipment at three additional locations. These amendments are supported by signatories to the Radiology MoU, the radiology profession as represented by the Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association.
The Cardiac Imaging and Obstetric and Gynaecological Ultrasound MoUs will not be affected.
The Act specifies no conditions that need to be satisfied before the power to make the Regulations may be exercised.
The Regulations are a legislative instrument for the purposes of the Legislative Instruments Act 2003.
The Regulations commence on 1 November 2006.
Authority: Subsection 133(1) of the Health Insurance Act 1973
Details of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2006
Regulation 1 – Name of Regulations
This regulation provides that the title of the Regulations is the Health Insurance (Diagnostic Imaging Services Table) Regulations 2006.
Regulation 2 - Commencement
This regulation provides for the Regulations to commence on 1 November 2006.
Regulation 3 – Repeal
This regulation repeals the Health Insurance (Diagnostic Imaging Services Table) Regulations 2005 (as amended).
Regulation 4 - Definitions
Regulation 4 provides that for the purpose of the Regulations, Act means the Health Insurance Act 1973 and this table means these Regulations.
Regulation 5
Regulation 5 provides that the table of diagnostic imaging services in Schedule 1 is prescribed for the purposes of subsection 4AA(1) of the Act.
Schedule 1 - Table of diagnostic imaging services amendments
In addition to remaking the table contained in the Health Insurance (Diagnostic Imaging Services Table) Regulations 2005, the Diagnostic Imaging Services Table 2006 will amend:
§ Part 2 – Rules of interpretation; and
§ Part 3 – Services and fees.
Rule of interpretation 5(2)(a) will be amended to include item 55135 to provide that this item of service has certain reporting requirements. This service was previously overlooked.
Rules of interpretation 12(1) and 13 will be amended to remove references to item 55728. In consultation with the Obstetrics and Gynaecological Ultrasound profession it was agreed that, due to low usage, this item and all references to it would be removed.
The amendment to subrule 31(2) will mean that a Medicare benefit will only be payable for an MRI service performed with the specified equipment where the patient is bulk-billed in respect of the fee for the service.
The amendment to subrule 34(2) will mean that an MRI service performed with the specified equipment will only be Medicare eligible if the service is performed under the professional supervision of, and reported by, a specialist in diagnostic radiology who participates in the Royal Australian and New Zealand College of Radiologists’ Quality and Accreditation Program.
The amendment to rule 36 will provide that the specified equipment will be Medicare eligible if the equipment:
(a) is located at the place specified in the regulations for that equipment; and
(b) forms part of a comprehensive radiology department at the relevant location that provides, at a minimum, x-ray, computed tomography and ultrasound services; and
(c) is available for use from 9 am to 5 pm each Monday to Friday (excluding public holidays) for routine services, except for periods reasonably required for necessary maintenance, repairs and upgrades; and
(d) is available for use at all times for emergency services, except for periods of reasonably required for necessary maintenance, repairs and upgrades.